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Trauma-Informed Schools Part 2:Trauma Sensitive Practices
Dr. Briana Woods-Jaeger
Assistant Professor
Rollins School of Public Health
Licensed Clinical Psychologist
Briana Woods-Jaeger, PhD, MS
Rollins School of Public Health, Emory University
Southeast Region MHTTC
Disclaimer: The opinions expressed herein are the views of the presenters and do not reflect the official
position of the Department of Health and Human Services (DHHS), SAMHSA. No official support or
endorsement of DHHS, SAMHSA, for the opinions described in this document is intended or should be
inferred.
ObjectivesDescribe approaches to implement
trauma-informed practices in schools
Provide examples of trauma-informed programs and practices
Discuss staff wellness as a foundation for trauma-informed
schools
Describe staff wellness tools and resources
1
2
3
4
School Mental Health Interventions
4
Multi-Tiered Approach
Universal: target whole
school or classrooms
• Least intrusive, lowest cost
• Greatest chance of adoption
• Can be easier than other approaches
• Need buy in from administrative leaders and
all school staff
Fazel et al., 2014
School Mental Health Interventions
5
Multi-Tiered Approach
Selective: targeted to
population subgroups,
address risk factors
within higher risk
groups
• Promote awareness of alternative coping
strategies
• Reduce development of some problem
behaviors
• Can be delivered in classrooms or small
groups for students at high risk
• Strong evidence for students with risk factors
and for students with anxiety or depressive
disorders
Fazel et al., 2014
School Mental Health Interventions
6
Multi-Tiered Approach
Indicated: overlap
conceptually with
mental health
treatments; can
include services
delivered by staff
employed by
community-based
agencies
• Generally show stronger outcomes for clinical
impairment than universal or selective
interventions
• Community-partnered mental health services
• Consultation in mainstream schools by mental
health specialists
• Some schools provide onsite individual, family
and group treatment
• Intensive treatment can take place during the
school day – more efficient for students and
parents
Fazel et al., 2014
Core Areas of a Trauma-Informed School
1. Identifying and Assessing Traumatic Stress
2. Addressing and Treating Traumatic Stress
3. Trauma Education and Awareness
4. Partnerships with Students and Families
5. Creating a Trauma-Informed Learning Environment
6. Cultural Responsiveness
7. Emergency Management/Crisis Response
8. Staff Self-Care and Secondary Traumatic Stress
9. School Discipline Policies and Practices
10. Cross System Collaboration and Community Partnerships
NCTSN, 2017
Barriers to Becoming and Sustaining a Trauma-Informed School
• Limited staffing and funding to screen for trauma
• Lack of availability of appropriate tools and resources
• Limited capacity of schools to follow-up with students identified as needing services
• District-level leadership changes
• Workforce instability
• Shifting school and district priorities
Overstreet & Chafouleas, 2016
Poll Question:“What are barriers you have
faced in becoming a trauma-informed school?”
Facilitators to Becoming and Sustaining a Trauma-Informed School
• Use of familiar frameworks (e.g., MTSS) to align trauma-informed
approaches with existing educational practices
• Building from effective school-based mental health models and practices
• Use of naturalistic resources (i.e., teachers, peers) within schools to
implement and sustain supports
• Peer-selected key opinion leader (KOLs) teachers to promote new
strategies
• Inclusion of integrated models
• Strengthening the active involvement of parents
Atkins et al., 2008; Atkins et al., 2010; Overstreet & Chafouleas, 2016
Examples of Trauma-Informed Programs & Practices in Schools
MTSS Approach to TIS
Brymer et al., 2012; CBITS, n.d.
Trauma-Informed Training
• Increase staff knowledge about prevalence and effects of trauma
• Increase staff’s ability to recognize signs and symptoms of trauma
• Improve staff skills in appropriately responding to students exhibiting trauma symptoms
• Effectively address student behavior
• Make appropriate referrals
• Recognize and address secondary traumatic stress and burnout • Staff Wellness*
Maynard et al. 2019
Psychological First Aid for Schools (PFA-S)
• Designed to reduce the initial distress caused by emergencies and to foster short- and long-term adaptive functioning and coping
• Identifies individuals who may need additional services and links them to such services as needed
• Potential to mitigate the development of mental health problems or long-term difficulties in recovery
Brymer et al., 2012
PFA Core ActionsGoal: To initiate contacts or to respond to contacts by students and staff in a non-intrusive, compassionate, and helpful manner
Contact and Engagement
Goal: To enhance immediate and ongoing safety, and provide physical and emotional comfortSafety and Comfort
Goal: To calm and orient emotionally overwhelmed or disoriented students and staffStabilization (if needed)
Goal: To identify immediate needs and concerns, gather additional information, and tailor Psychological First Aid for Schools interventions to meet these needs
Information Gathering:
Current Needs and Concerns
Goal: To offer practical help to students and staff in addressing immediate needs and concernsPractical Assistance
Goal: To help establish brief or ongoing contacts with primary support persons or other sources of support, including family, friends, teachers, and other school and/or community resources
Connection with
Social Supports
Goal: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning
Information on Coping
Goal: To link students and staff with available services needed at the time or in the future
Linkage with
Collaborative Services
Brymer et al., 2012
PFA-S Resources
Schools can find training resources including the PFA-S Field Operations Guide, https://www.nctsn.org/resources/all-nctsn-resources.
• PFA-S Field Operations Guide: provides guidance on responding to
disaster, violence, or terrorism events using the Psychological First Aid
intervention.
• PFA-S Webinar: describes the fundamentals of Psychological First Aid
for Schools. This webinar offers information on how PFA-S helps to
reduce the distress that school communities can experience after a
disaster or violent event.
PFA Example Intervention: Link
Communication Skills
Stress Screener
Referral to Resources
Link in Schools Video
Link in Schools Pilot Data:Depressive & PTSD Symptoms
1 Repeated measures ANOVA model controls for student race, grade and sex, flood versus other disaster and correlation within schools
*P <0.05 from baseline.
**
*
Ramirez et al. 2013
Hospital-based Link Study
Children who received LINK
had significantly improved
child behaviors compared to
children who received
educational materials:
Peer relationships
problems (p=.0240)
Conduct problems (p=
.0368)
UI Children’s Hospital
Blank Children’s Hospital
Children’s Minnesota
Children’s Mercy, Kansas City
Link in Schools Process
summer/early fall summer/early fall fall & spring end of year
Trauma Informed
Care training
delivered to all
school staff
Implement Link Program:
At-risk youth (identified using existing
school systems) receive one-on-one
Link session
End-of-year Link
de-briefing
On-going Link
mentoring
Specialists
receive Link
training
Cognitive Behavioral Intervention for Trauma in Schools (CBITS)
• School-based, group and individual intervention; used with students 5th-12th grade
• Evidence-based intervention program developed for diverse youth exposed to trauma
• Reduce symptoms of post-traumatic stress disorder (PTSD), depression, and behavioral problems
• Improves functioning, grades and attendance, peer and parent support and coping skills
21CBITS, n.d.
Program Components
10 group sessions
1-3 individual sessions
2 parent psychoeducational
sessions
1 teacher educational session
Statewide Implementation of CBITS
20 Clinicians
5 school-based mental health provider organizations
Inputs
73 CBITS groups
350 racially and ethnically diverse students served
Activities Significant reductions in child PTSD symptoms and problem severity
Positive impact on students’ psychosocial and academic functioning
Outcomes
Hoover et al., 2018
CBITS Resources
Schools can find training resources including the CBITS fact sheet and culturally-specific fact sheet, https://www.nctsn.org/interventions/cognitive-behavioral-intervention-trauma-schools.
Schools can access a host of free resources, including everything needed to implement CBITS in a school, at https://cbitsprogram.org/.
CBITS Dissemination and Sustainability• Madison, Wisconsin
• Journey Mental Health Center in Dane County,
Wisconsin implemented CBITS in local public
schools since 2004.
• Originally funded by SAMHSA now funded
through the United Way of Dane County.
• Los Angeles, California• School Mental Health, an office of the Los Angeles
Unified School District, used a reflective learning
group model (a weekly training and supervision
process from preimplementation to outcome
evaluation) to implement CBITS during 2008-2010.
• They trained 107 staff, offered 117 groups, and
served more than 700 students in approximately
100 schools.
• Baltimore, Maryland• Since 2004, the University of Maryland has been
implementing CBITS in schools throughout the
state
• The Center for School Mental Health and the
School Mental Health Program, both in the School
of Medicine, initially received funding from the
Maryland Department of Health and Mental
Hygiene
• New Orleans, Louisiana• In response to Hurricane Katrina, Mercy Family
Center created Project Fleur-de-lis, a collaborative
partnership among schools, social service
agencies, and national experts to provide mental
health services within New Orleans-area schools.
• Funded through NCTSN and the Louisiana
Children’s Trust Fund
CBITS, n.d.
Staff Wellness as a Foundation
Teachers working with Trauma
• Teachers may experience secondary traumatic stress from working with student trauma
• Teachers express uncertainty and need for additional training related to childhood trauma
• Exposure to trauma-focused training, involvement with students who have experienced trauma, and teaching experience build trauma-related confidence
Alisic et al., 2012; Berger et al., 2016
Vicarious trauma & Compassion fatigueo Vicarious trauma is change resulting
from continuous empathic engagement with trauma survivors
o The “emotional residue” from working with children and families living with chronic stress and trauma
o May lead to changes in one’s sense of self, world view, and spiritual beliefs
o Compassion fatigue is emotional, physical, and spiritual exhaustion from witnessing and absorbing the problems and suffering of others
o Results from chronic use of empathy plus day-to-day bureaucratic hurdles
Vicarious trauma symptoms include:
Being jumpy or easily startled
Feeling trapped by one’s occupation
Free-floating anxiety or irritation
Hopelessness
Detachment from or avoidance of students and
their issues
Newell & MacNeil, 2010; Hunsaker et al., 2015
Promoting Staff WellnessSelf-assessment
Professional Quality of Life Scale
• Questions about your experiences as a caregiver in the last 30 days
• Compassion Satisfaction – pleasure you derive from being able to do your work well
• Burnout- associated with feelings of hopelessness and difficulties in dealing with work or doing job effectively
• Secondary traumatic stress- if exposed to others traumatic events as a result of the work you do may experience symptoms of traumatic stress (jumpy; images of event pop into your mind; problems with sleep)
Stamm, 2010
Professional Quality of Life Scale: Example Questions Secondary Traumatic Stress
I am preoccupied with more than one person I [help].
Because of my [helping], I have felt "on edge" about various things.
I avoid certain activities or situations because they remind me of frightening experiences of the people
I [help]
Compassion Satisfaction
I believe I can make a difference through my work.
I am proud of what I can do to [help].
I have thoughts that I am a “success” as a [helper].
Burnout
I feel worn out because of my work as a [helper].
I feel "bogged down" by the system.
Stamm, 2010
Professional Quality of Life Scale
• ProQOL administered individually or in groups
• Self-score option
• Part of ongoing self-care plan
• Important to establish what will happen with data because data privacy are important
• Feedback can include general information such as “others who score similarly to you” or may be more specific
• Feedback in group settings should not be about an individual but about things that apply to more than one person
• Be prepared to give clear information and answer questions
Stamm, 2010
Professional Quality of Life Scale
• ProQOL is not diagnostic• May raise issues to address with appropriate diagnostic
procedures
• Can be a guide for an individual or organization in regard to balance of positive and negative experiences at work, self-care or organizational wellness plans
• Can self-administer at regular self-determined intervals as regular check in
Stamm, 2010
Poll Question: What are some ideas for
promoting staff wellness in your school/organization?
Promoting Staff WellnessSelf-Care Tools & Techniques
Self-Care Strategies Worksheet
Belonging to positive social networks; maintaining relationships with friends; attending social activities or events.
Social
Self-Care
Appropriate exercise; proper eating habits; proper amount of sleep; joining gyms or exercise clubs.
Physical
Self-Care
Reading books; attending work-shops or seminars; learning a new craft or developing a new hobby.
Intellectual
Self-Care
Itemizing bills; monitoring expenses; incorporating expenses for leisure activities; talking with a financial consultant.
Financial
Self-care
Taking steps to reconnect with your Higher Power; attending religious services; participating in study groups; daily reflection on your purpose in life.
Spiritual
Self-Care
Taking a walk outdoors; creating a specific space in your home that is reserved only for healthy activities or rest; camping or contributing to an environmentally sound cause.
Environmental
Self-Care
Hydon et al. 2015
Professional Self-Care Card
36
Get Ready/Get Set In the Moment After-care
Coffee Name my emotion Take a walk
Exercise Consultation with
colleague
Play with dog
Prioritize my daily tasks Deep breathing
exercises
Romantic comedies
Poll Question:What comes to mind when you
hear the word mindfulness?
Mindfulness Definitions
• Intentionally living with awareness in the present moment
• Without judging or rejecting
• Without attaching or holding on to
• Mindfulness can be practiced at any time, anywhere, while
doing anything
Mindfulness Benefits
• Mindfulness may not reduce stressors, but it can help you manage stress by providing you with additional ways of coping with stress.
• Practicing mindfulness can be used to:
• Develop a broader perspective of life and a sense of connectedness with others
• Sharpen concentration, allowing greater focus in the activities we undertake in our lives
• Help to cope with stress, anger, and other forms of emotion
• Engage in the present and experience life in a richer, fuller way
International Society for Traumatic Studies
Mindfulness Benefits
Flook et al., 2013; Roeser et al., 2012
• Teaching can be uncertain, emotional, and attentionally demanding
• Requires mental flexibility, emotion regulation and relationship management skills
• Teachers have to problem solve on the fly while also expressing a range of emotions
• Pilot randomized controlled trial of modified Mindfulness-Based Stress Reduction course for teachers showed:
• Significant reductions in psychological symptoms and burnout • Improvements in observer-rated classroom organization • Increases in self-compassion
Ideas for Quick Mindfulness Practice
Possible Next Steps…
“The Flexible Framework,” n.d.
LEADERSHIP: SCHOOL ADMINISTRATORS CREATE
INFRASTRUCTURE AND CULTURE THAT PROMOTES TRAUMA
SENSITIVITY
PROFESSIONAL DEVELOPMENT: BUILD SKILLS THAT ENHANCE
CAPACITY TO CREATE A TRAUMA SENSITIVE LEARNING
ENVIRONMENT
ACCESS TO RESOURCES AND SERVICES: COORDINATE WITH MENTAL HEALTH AND OTHER
SERVICES OUTSIDE THE SCHOOL; SUPPORT STAFF TO REFLECT HOW WORK AFFECTS THEIR OWN LIVES
Possible Next Steps…
ACADEMIC AND NONACADEMIC STRATEGIES: IDENTIFY AND BUILD ON STUDENTS’ STRENGTHS AND ENSURE A SAFE ENVIRONMENT
POLICIES AND PROTOCOLS: REVIEW POLICIES AND
PROTOCOLS FOR DAY TO DAY ACTIVITIES AND LOGISTICS TO ENSURE TRAUMA SENSITIVE
ENVIRONMENT
COLLABORATION WITH FAMILIES: ENGAGE FAMILIES IN ALL ASPECTS
OF THEIR CHILD’S EDUCATION
“The Flexible Framework,” n.d.
References• Atkins, M. S., Frazier, S. L., Leathers, S. J., Graczyk, P. A., Talbott, E., Jakobsons, L., ... & Bell, C. C. (2008). Teacher
key opinion leaders and mental health consultation in low-income urban schools. Journal of Consulting and Clinical Psychology, 76(5), 905.
• Atkins, M. S., Hoagwood, K. E., Kutash, K., & Seidman, E. (2010). Toward the integration of education and mental health in schools. Administration and Policy in Mental Health and Mental Health Services Research, 37(1-2), 40-47
• Alisic, E., Bus, M., Dulack, W., Pennings, L., & Splinter, J. (2012). Teachers experiences supporting children after traumatic exposure. Journal of Traumatic Stress, 25, 98-101.
• Berger, R., Abu-Raiya, H., & Benatov, J. (2016). Reducing primary and secondary traumatic stress symptoms among educators by training them to deliver a resiliency program (ERASE-Stress) following the Christchurch earthquake in New Zealand. American Journal of Orthopsychatiry, 86, 236-251.
• Brymer M., Taylor M., Escudero P., Jacobs A., Kronenberg M., Macy R., Mock L., Payne L., Pynoos R., & Vogel J. Psychological first aid for schools: Field operations guide, 2nd Edition. (2012). Los Angeles: National Child Traumatic Stress Network.
• Cognitive Behavioral Intervention for Trauma in Schools (CBITS). (n.d.). Retrieved from https://cbitsprogram.org/
• Fazel, M., Hoagwood, K., Stephan, S., & Ford, T. (2014). Mental health interventions in schools in high-income countries. The Lancet Psychiatry, 1(5), 377-387.
• Flook, L., Goldberg, S. B., Pinger, L., Bonus, K., & Davidson, R. J. (2013). Mindfulness for teachers: A pilot study to assess effects on stress, burnout, and teaching efficacy. Mind, Brain, and Education, 7(3), 182-195.
• Hoover, S. A., Sapere, H., Lang, J. M., Nadeem, E., Dean, K. L., & Vona, P. (2018). Statewide implementation of an evidence-based trauma intervention in schools. School Psychology Quarterly, 33(1), 44.
• Hunsaker, S., Chen, H. C., Maughan, D., & Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship, 47(2), 186-194.
References
• Hydon, S., Wong, M., Langley, A.K., Stein, B.D., Kataoka, S.H. (2015). Preventing secondary traumatic stress in educators. Child & Adolescent Psychiatric Clinics of North America 24, 319–333.
• International Society for Traumatic Studies: https://www.istss.org/education research/online learning
• Maynard, B. R., Farina, A., & Dell, N. A. (2017). Effects of trauma-informed approaches in schools. Downloaded October, 6, 2018.
• National Child Traumatic Stress Network (NCTSN), Schools Committee. (2017). Creating, supporting, and sustaining trauma-informed schools: A system framework. Los Angeles, CA and Durham, NC: National Center for Child Traumatic Stress.
• Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue. Best Practices in Mental Health, 6(2), 57-68.
• Overstreet, S. & Chafouleas, S.M. (2016). Trauma-informed schools: Introduction to the special issue. School Mental Health, 8, 1-6.
• Ramirez, M., Harland, K., Frederick, M., Shepherd, R., Wong, M., & Cavanaugh, J. E. (2013). Listen protect connect for traumatized schoolchildren: a pilot study of psychological first aid. BMC psychology, 1(1), 26.
• Roeser, R. W., Skinner, E., Beers, J., & Jennings, P. A. (2012). Mindfulness training and teachers' professional development: An emerging area of research and practice. Child Development Perspectives, 6(2), 167-173.
• Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org.
• The Flexible Framework: Six Elements of School Operations Involved in Creating a Trauma-Sensitive School. (n.d.). Retrieved from https://traumasensitiveschools.org/trauma-and-learning/the-flexible-framework/